Doctor Name: | TRACY L ESTRELLADO |
NPI Number: | 1083645733 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | PA-C |
License Number: | PA10002438 |
Business Practice Address: | 840 E Hill Ave Moses Lake, WA - 988372238 |
Business Phone Number: | 5097650216 |
Business Fax Number: | |
Mailing Address: | 820 N Chelan Ave, WENATCHEE |
State: | WA |
Postal Code: | 988012028 |
Phone Number: | |
Fax Number: | |
NPI Enumeration Date: | 07/05/2006 |
NPI Last Update Date: | 02/17/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 363AM0700X |
License Number: | PA10002438 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | WA |
Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
Taxonomy Classification: | Physician Assistant |
Taxonomy Specialization: | Medical |
Taxonomy Definition: |